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Lin W. Association Between Time to First Cigarette Use and Urine Biomarkers of Tobacco Exposure in Adult Smokers. Lung 2024; 202:217-219. [PMID: 38386078 DOI: 10.1007/s00408-024-00684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Wenxue Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, 19122, USA.
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2
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Veiga Vasques AM, da Silva ACR, Bueno CRE, Duarte MAH, Ervolino E, Cintra LTA, Dezan Junior E. Bone Resorption in Apical Periodontitis Enhanced by Cigarette Smoke Inhalation: Histometric, Immunohistochemical, and Microtomographic Analysis in Rats. J Endod 2024; 50:493-498. [PMID: 38272443 DOI: 10.1016/j.joen.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION This study evaluated the effects of cigarette smoke inhalation (CSI) on apical periodontitis (AP) induced in rats by histometric, immunohistochemical, and microtomographic analysis. METHODS A total of 32 male Wistar rats were divided into 4 experimental groups (n = 8): control, CSI, AP, and CSI + AP. Rats in the CSI and CSI + AP groups inhaled cigarette smoke by remaining inside a smoking chamber for 8 minutes 3 times a day for 50 days. After 20 days of smoke inhalation, rats in the AP and CSI + AP groups had the pulp of their first right lower molar exposed to induce AP. Blood was collected on day 50 to evaluate nicotine and serum cotinine levels. The animals' mandibles were removed for histologic processing to evaluate bone resorption by histometric, immunohistochemical (receptor activator of nuclear factor kappa B ligand/osteoprotegerin), and microtomographic analysis. The Student t test was applied. RESULTS Histometric analysis showed a larger area of bone resorption (P < .05) and microtomographic analysis found greater resorption volume (P < .001) for the CSI + AP group compared with the AP group. The CSI + AP group presented a high RANKL immunostaining pattern compared with the AP group (P < .001). CONCLUSIONS CSI increased bone resorption caused by AP.
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Affiliation(s)
- Ana Maria Veiga Vasques
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University, Araçatuba, Brazil
| | - Ana Claudia Rodrigues da Silva
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University, Araçatuba, Brazil
| | - Carlos Roberto Emerenciano Bueno
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University, Araçatuba, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Edilson Ervolino
- Department of Basic Science, School of Dentistry, São Paulo State University, Araçatuba, Brazil
| | - Luciano Tavares Angelo Cintra
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University, Araçatuba, Brazil
| | - Eloi Dezan Junior
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University, Araçatuba, Brazil.
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Alrowais FS, AlShenaifi AM, Alghufaily MK, Alqudah OM, Al-Bashaireh AM. Client's perception toward services of smoking cessation clinics in Riyadh, Saudi Arabia. J Family Med Prim Care 2024; 13:1296-1302. [PMID: 38827688 PMCID: PMC11141994 DOI: 10.4103/jfmpc.jfmpc_1344_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 06/04/2024] Open
Abstract
Background In Saudi Arabia, approximately 70,000 deaths yearly occur from diseases caused by smoking. Assessing patients' smoking behavior in primary care has apparent benefits. Assisting patients with smoking cessation is one of the essential roles of primary care. This study evaluated the quality of smoking cessation clinic counseling in Riyadh, Saudi Arabia, based on customer opinions of such services. Methods This research employed a cross-sectional approach involving individuals attending smoking cessation clinics located within primary health care centers in Riyadh city. The participants were chosen through random selection. They were informed about the study's objectives, and those who consented to take part were contacted and provided with an online questionnaire to complete. Results A total of 340 subjects participated (95.6%) of them were males, and 41.2% were in the age group of 25 to 35 years old. The common modality of tobacco use was cigarettes (82.6%), and 87.9% reported consuming tobacco daily. The mean (±SD) total score of the Fagerstrom Test of Nicotine Dependence was 5.03 (±2.36), and the highest percentage (44.4%) of the participants had a moderate level of nicotine dependence. The vast majority (93.8%) of the participants had former quitting experiences. Half (50.9%) of the participants showed complete satisfaction with the cessation clinics, while 13.2% and 9.1% of them were not satisfied or slightly satisfied, respectively. Conclusion The majority of smoking cessation clinic visitors were satisfied with the services provided, exceeding three-quarters of them, with half totally satisfied.
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Affiliation(s)
- Fai S. Alrowais
- Family Medicine Physician, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | - Ola M. Alqudah
- Family Medicine Consultant, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad M. Al-Bashaireh
- Faculty of Health Science, Higher Colleges of Technology, Fujairah, United Arab Emirates
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Zhu J, Branstetter S, Lazarus P, Muscat JE. Smoking, Lung Cancer Stage, and Prognostic Factors-Findings from the National Lung Screening Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:400. [PMID: 38673313 PMCID: PMC11050078 DOI: 10.3390/ijerph21040400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) increases the early detection of lung cancer. Identifying modifiable behaviors that may affect tumor progression in LDCT-detected patients increases the likelihood of long-term survival and a good quality of life. METHODS We examined cigarette smoking behaviors on lung cancer stage, progression, and survival in 299 ever-smoking patients with low-dose CT-detected tumors from the National Lung Screening Trial. Univariate and multivariate Cox models were used to estimate the hazard ratio (HR) for smoking variables on survival time. RESULTS Current vs. former smokers and early morning smokers (≤5 min after waking, i.e., time to first cigarette (TTFC) ≤ 5 min) had more advanced-stage lung cancer. The adjusted HR for current vs. former smokers was 1.3 (95% confidence interval [CI] 0.911-1.98, p = 0.136) for overall survival (OS) and 1.3 (0.893-1.87, p = 0.1736) for progression-free survival (PFS). The univariate hazard ratios for TTFC ≤ 5 min vs. >5 min were 1.56 (1.1-2.2, p = 0.013) for OS and 1.53 (1.1-2.12, p = 0.01) for PFS. Among current smokers, the corresponding HRs for early TTFC were 1.78 (1.16-2.74, p = 0.0088) and 1.95 (1.29-2.95, p = 0.0016) for OS and PFS, respectively. In causal mediation analysis, the TTFC effect on survival time was mediated entirely through lung cancer stage. CONCLUSION The current findings indicate smoking behaviors at diagnosis may affect lung cancer stage and prognosis.
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Affiliation(s)
- Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Steven Branstetter
- Department of Biobehavioral Heath, Penn State University, University Park, PA 16802, USA;
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA;
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
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Zhu N, Zhu J, Lin S, Yu H, Cao C. Correlation analysis between smoke exposure and serum neurofilament light chain in adults: a cross-sectional study. BMC Public Health 2024; 24:353. [PMID: 38308244 PMCID: PMC10835908 DOI: 10.1186/s12889-024-17811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Smoke exposure is a prevalent and well-documented risk factor for various diseases across different organ systems. Serum neurofilament light chain (sNfL) has emerged as a promising biomarker for a multitude of nervous system disorders. However, there is a notable paucity of research exploring the associations between smoke exposure and sNfL levels. METHODS We conducted a comprehensive analysis of the National Health and Nutrition Examination Survey (NHANES) cross-sectional data spanning the years 2013 to 2014. Serum cotinine levels were classified into the following three groups: < 0.05, 0.05-2.99, and ≥ 3 ng/ml. Multiple linear regression models were employed to assess the relationships between serum cotinine levels and sNfL levels. Additionally, we utilized restricted cubic spline analyses to elucidate the potential nonlinear relationship between serum cotinine and sNfL levels. RESULTS A total of 2053 participants were included in our present research. Among these individuals, the mean age was 47.04 ± 15.32 years, and males accounted for 48.2% of the total study population. After adjusting the full model, serum cotinine was positively correlated with sNfl in the second group (β = 0.08, 95%CI 0.01-0.15) and in the highest concentration of serum cotinine (β = 0.10, 95%CI 0.01-0.19) compared to the group with the lowest serum cotinine concentrations. Current smokers, in comparison to non-smokers, exhibited a trend toward elevated sNfL levels (β = 0.07, 95%CI 0.01-0.13). Furthermore, subgroup analyses revealed interactions between serum cotinine levels and different age groups (P for interaction = 0.001) and gender stratification (P for interaction = 0.015) on sNfL levels. CONCLUSION The study suggested that serum cotinine was significantly and positively associated with sNfl levels in adult participants. Furthermore, current smokers tend to exhibit elevated sNfL levels. This research sheds light on the potential implications of smoke exposure on neurological function impairment and underscores the importance of further exploration in this area.
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Affiliation(s)
- Ning Zhu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, 315010, Ningbo, Zhejiang, China
| | - Jing Zhu
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Shanhong Lin
- Department of Ultrasound, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, 315010, Ningbo, Zhejiang, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, 315010, Ningbo, Zhejiang, China.
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Borrego‐Soto G, Perez‐Paramo YX, Hernández‐Cabrera F, Alvarado‐Monroy FM, Borrego G, Robles‐Zamora A, Lazarus P, Rojas‐Martinez A. Biochemical and genetic biomarkers associated with nicotine dependence in Mexican smokers. Pharmacol Res Perspect 2023; 11:e01142. [PMID: 37787014 PMCID: PMC10546262 DOI: 10.1002/prp2.1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023] Open
Abstract
Cigarette smoking remains an important health concern and is still a leading cause of preventable mortality. Nicotine is the substance responsible for sustained tobacco use and dependence. Identification of biomarkers underlying nicotine dependence behavior is important to identify people at risk for this dependence. In the present study, we identified biochemical and genetic biomarkers of nicotine dependence detected by the Fagerström Test for Nicotine Dependence (FTDN) in Mexican smokers. The nicotine metabolites nicotine-N'-oxide, trans-3'-hydroxycotinine-glucuronide (3HC-O-Gluc), and nicotine-N-Gluc (Gluc) were useful to differentiate nicotine-dependent from non-dependent subjects (p < .0001) with an area under the curve (AUC) of 0.7818. Genetic variants in CYP2A6, FMO3, and UGT2B7 (rs2431413, rs28363545, and rs7439326, respectively) were associated with nicotine dependence (p = .03, p = .01, p = .01, respectively). Variations in the enzymatic activity of CYP2A6 were associated with altered nicotine-N'-oxide and 3HC-O-Gluc levels. Decreased urinary levels of 3HC-O-Gluc and increased nicotine-N'-oxide were associated with a decrease in the functional activity of CYP2A6. A strong positive correlation was observed between the ratio of urinary 3HC/cotinine, a measure of CYP2A6 activity, and the levels of 3HC-O-Gluc (p < .0001, r = .6835), while a strong negative correlation was observed with nicotine-N'-oxide (p < .0001, r = .6522) in nicotine-dependent subjects. No correlations were observed in non-nicotine-dependent subjects. These data suggest that particular urinary nicotine metabolites and genetic variants involved in nicotine metabolism are useful to identify subjects with nicotine dependence in the Mexican population.
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Affiliation(s)
- Gissela Borrego‐Soto
- Department of Molecular Biosciences, School of Natural SciencesUniversity of Texas at AustinAustinTexasUSA
| | - Yadira Xitlalli Perez‐Paramo
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical SciencesWashington State UniversitySpokaneWashingtonUSA
| | - Francisco Hernández‐Cabrera
- Department of Bioinformatics and Complex Systems, Facultad de Ciencias Físico MatemáticasUniversidad Autonoma de Nuevo LeonSan Nicolás de los GarzaMexico
| | | | - Gilberto Borrego
- Department of Computer science and designInstituto Tecnologico de SonoraObregonMexico
| | | | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical SciencesWashington State UniversitySpokaneWashingtonUSA
| | - Augusto Rojas‐Martinez
- Tecnologico de Monterrey, The Institute for Obesity Research and Escuela de Medicina y Ciencias de la SaludMonterreyMexico
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Saha P, Jain S, Mukherjee I, Panda SR, Zeki AA, Naidu V, Sharma P. The effects of dual IQOS and cigarette smoke exposure on airway epithelial cells: implications for lung health and respiratory disease pathogenesis. ERJ Open Res 2023; 9:00558-2022. [PMID: 37260462 PMCID: PMC10227640 DOI: 10.1183/23120541.00558-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Background Cigarette smoking remains a primary cause of chronic lung diseases. After a steady decline, smoking rates have recently increased especially with the introduction of newer electronic nicotine delivery devices, and it is also emerging that dual- or poly-product usage is on the rise. Additionally, with the introduction of IQOS (a heated tobacco product) globally, its impact on human health needs to be investigated. In this study we tested if dual exposure (cigarette smoke (CS)+IQOS) is detrimental to lung epithelial cells when compared with CS or IQOS exposure alone. Methods Human airway epithelial cells (BEAS-2B) were exposed to either CS, IQOS or their dual combination (CS+IQOS) at concentrations of 0.1%, 1.0%, 2.5% and 5.0%. Cytotoxicity, oxidative stress, mitochondrial homeostasis, mitophagy and effects on epithelial-mesenchymal transition (EMT) signalling were assessed. Results Both CS and IQOS alone significantly induced loss of cell viability in a concentration-dependent manner which was further enhanced by dual exposure compared with IQOS alone (p<0.01). Dual exposure significantly increased oxidative stress and perturbed mitochondrial homeostasis when compared with CS or IQOS alone (p<0.05). Additionally, dual exposure induced EMT signalling as shown by increased mesenchymal (α-smooth muscle actin and N-cadherin) and decreased epithelial (E-cadherin) markers when compared with CS or IQOS alone (p<0.05). Conclusion Collectively, our study demonstrates that dual CS+IQOS exposure enhances pathogenic signalling mediated by oxidative stress and mitochondrial dysfunction leading to EMT activation, which is an important regulator of small airway fibrosis in obstructive lung diseases.
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Affiliation(s)
- Pritam Saha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
- These authors contributed equally
| | - Siddhi Jain
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
- These authors contributed equally
| | - Ipsita Mukherjee
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
- These authors contributed equally
| | - Samir R. Panda
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
| | - Amir A. Zeki
- UC Davis School of Medicine, UC Davis Lung Center and Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California – Davis, Sacramento, CA, USA
| | - V.G.M. Naidu
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
| | - Pawan Sharma
- Center for Translational Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Machiorlatti M, Krebs N, Sun D, Muscat JE. Diurnal variability of cortisol in the Pennsylvania adult smoking study: Exploration of association with nicotine intake. Int J Psychophysiol 2023; 186:24-32. [PMID: 36764583 PMCID: PMC10013170 DOI: 10.1016/j.ijpsycho.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/16/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
Cortisol in saliva, urine and plasma follows a diurnal rhythm typically characterized as a morning peak and a decline throughout the waking day. While often measured under controlled conditions, inter-individual differences in cortisol diurnal rhythms in free living populations are not well characterized. Cortisol levels may vary substantially between individuals and the level of variation may differ depending on the time of day. Further, associations with individual characteristics such as nicotine dependence on cortisol rhythms have not been adequately determined. We developed a Liquid Chromatography-Tandem Mass Spectrometry method to measure cortisol in saliva of 180 smokers from the Pennsylvania Adult Smoking Study. Diurnal patters of cortisol were determined by obtaining five timed samples throughout the day for a total of 900 determinations. Adherence to the protocol was estimated by asking participants to record the time of sample collection. Longitudinal linear mixed effects models were developed to measure the predictors of mean levels. Phenotypic groups were constructed based on the minimum and maximum cortisol levels. Mixed method modelling was conducted to determine the effects of phenotype and study adherence as well as reported measures of stress, nicotine dependence and cigarette smoking frequency. Nicotine metabolites were measured to accurately quantify dose of smoking intake. Results showed that there was moderate compliance to the timed protocol. Descriptive and analytic findings showed that some smokers had atypical cortisol patterns, and that the cortisol profiles based on experience of maximum and minimum cortisol levels can predict how cortisol varies throughout the day. There was no association with reported stress, cigarettes per day, and nicotine metabolites. There was no association with the Fagerstrom Test for Nicotine Dependence. The Hooked on Nicotine Checklist (HONC) score was associated with decreased cortisol levels. Overall these results show new approaches and expectations to population-based studies of cortisol.
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Affiliation(s)
- Michael Machiorlatti
- Population Health & Biostatistics, University of Texas Rio Grande Valley - School of Medicine, 2102 Treasure Hills Boulevard, Harlingen, TX 78550, United States
| | - Nicole Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, 500 University Drive, MC CH69, Hershey, PA 17033, United States
| | - Dongxiao Sun
- Department of Pharmacology, Penn State College of Medicine, Pennsylvania State University, 500 University Drive, MC CH69, Hershey, PA 17033, United States
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, 500 University Drive, MC CH69, Hershey, PA 17033, United States.
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Chen-Sankey J, Lopez M, Elhabashy M, Broun A. How the Other Half Sees It: E-cigarette Advertising Exposure and Subsequent E-cigarette Use Among U.S. Young Adult Cigarette Smokers. Nicotine Tob Res 2023; 25:453-461. [PMID: 35802421 PMCID: PMC10215982 DOI: 10.1093/ntr/ntac169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/26/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION E-cigarette advertising may benefit young adult cigarette smokers in transitioning to using e-cigarettes. We assessed whether e-cigarette advertising exposure was associated with subsequent e-cigarette use among young adult cigarette smokers. AIMS AND METHODS Data were from Waves 4 (2016-2018) and 5 (2018-2019) of the nationally representative Population Assessment of Tobacco and Health (PATH) study adult survey. Respondents were young adult established cigarette smokers at Wave 4 (18-34 years; n = 3391) and a subsample of those who tried to quit smoking cigarettes completely in the past year at Wave 5 (n = 1235). Multivariable logistic regressions were used to examine the associations between e-cigarette advertising exposure (by channel of exposure) and subsequent past-year e-cigarette use in general and e-cigarette use to quit smoking cigarettes, controlling for covariates. RESULTS At Wave 5, 43.4% of smokers reported past-year use of e-cigarettes; and 14.8% of smokers who tried to completely quit smoking reported past-year use of e-cigarettes to quit. E-cigarette advertising exposure was associated with subsequent past-year e-cigarette use (adjusted odds ratio [AOR] = 1.53, p < .0001, 95% confidence interval [CI] = 1.27, 1.86) and past-year use to quit smoking cigarettes (AOR = 1.65, p < .01, 95% CI = 1.19, 2.29). Advertising exposure through brick-and-mortar stores or websites/social media was similarly associated with both e-cigarette use behaviors. DISCUSSION Exposure to e-cigarette advertising among U.S. young adult established cigarette smokers may be associated with subsequent e-cigarette use and use to quit smoking. More research is needed to understand the features of e-cigarette advertising (eg, discounts, flavors, smoker-targeted claims) that may shape perception and behavior related to e-cigarette use among young adult smokers. IMPLICATIONS Little is known about the associations between e-cigarette advertising exposure and e-cigarette use among young adult cigarette smokers who may benefit from switching to e-cigarettes. This study found that e-cigarette advertising exposure was positively associated with (1) subsequent e-cigarette use among U.S. young adult established cigarette smokers and (2) subsequent e-cigarette use to quit smoking cigarettes among those who tried to completely quit in the past year. These observed associations were driven by smokers who did not currently use e-cigarettes at baseline. E-cigarette advertising exposure through brick-and-mortar stores or websites/social media was also positively associated with subsequent e-cigarette use behaviors.
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Affiliation(s)
- Julia Chen-Sankey
- Department of Health Behavior, Society, and Policy, Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Michael Lopez
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Maryam Elhabashy
- Department of Health Behavior, Society, and Policy, Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Aaron Broun
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Felicione NJ, Kaiser L, Leigh NJ, Page MK, Block AC, Schurr BE, O’Connor RJ, Goniewicz ML. Comparing POD and MOD ENDS Users' Product Characteristics, Use Behaviors, and Nicotine Exposure. Nicotine Tob Res 2023; 25:498-504. [PMID: 36073762 PMCID: PMC9910144 DOI: 10.1093/ntr/ntac211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION POD electronic nicotine delivery systems (ENDS), often containing high concentrations of nicotine salts, have replaced MODs (ie, open/modifiable devices) as the most popular devices. The purpose of this study was to compare device/liquid characteristics, use behavior, and nicotine exposure between POD and MOD users. METHODS Data from the initial visit of a prospective observational study of exclusive ENDS users compared MOD (n = 48) and POD (n = 37) users. Participants completed questionnaires on demographic characteristics, patterns of ENDS use, and ENDS features. A urine sample was collected to test for cotinine and an ENDS liquid sample was collected to test for nicotine and salts. Puff topography was captured during an ad libitum bout at the end of the session. RESULTS MOD and POD users did not differ on demographic characteristics. MOD users reported purchasing more liquid in the past month than POD users (180.4 ± 28.0 vs. 50.9 ± 9.0 ml, p < .001). Differences in characteristics of devices used by MOD and POD users included flavor type (p = .029), nicotine concentration (liquids used by MOD users contained less nicotine than those used by POD users: 8.9 ± 2.0 vs. 41.6 ± 3.2 mg/ml, p < .001), and presence of the nicotine salt (fewer MOD liquids had salts present than POD liquids: 11.9% vs. 77.4%, p < .001). User groups did not differ on urinary cotinine levels or puff topography (ps > .05). CONCLUSIONS Despite different characteristics of MOD and POD ENDS, users of those products are exposed to similar amounts of nicotine, likely due to using more liquid among MOD users. IMPLICATIONS This study directly compares ENDS product characteristics, user behavior, and nicotine exposure between MOD and POD ENDS users. Although POD products contained higher nicotine concentrations compared to MOD products, users of PODs reported consuming less liquid than MOD users. Ultimately, MOD and POD users were exposed to similar levels of nicotine, suggesting users behaviorally compensate for differences in product characteristics.
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Affiliation(s)
- Nicholas J Felicione
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lisa Kaiser
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Noel J Leigh
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ashleigh C Block
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bradley E Schurr
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Branstetter SA, Krebs NM, Muscat JE. Nighttime Waking to Smoke, Stress, and Nicotine Addiction. Behav Sleep Med 2022; 20:706-715. [PMID: 34666564 PMCID: PMC9016098 DOI: 10.1080/15402002.2021.1992408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Up to one-half of cigarette smokers may wake up during the night and smoke. This behavior may result in greater likelihood of cessation failure, clinically relevant sleep difficulties, and a range of health issues. Whereas the scientific literature has often attributed this behavior to nicotine dependence, up to 85% of smokers who wake at night and smoke attribute this behavior to factors other than nicotine. This study examines the relations between nicotine dependence, psychological distress, perceived stress, and waking at night to smoke. METHODS A total of 351 adult smokers from the Pennsylvania Adult Smoking Study (PASS) completed self-report surveys and provided saliva for the evaluation of cotinine values. Survey instruments included measures of nicotine addiction, perceived stress, a broad measure of global psychological distress, and a range of demographic factors. RESULTS Logistic regression demonstrated that nicotine addiction, psychological distress, and perceived stress were all related to waking at night to smoke, but cotinine levels were not. Mediation models found that psychological distress had a direct relation to waking at night to smoke, even when considering nicotine addiction and other causes of sleep disturbances (e.g., apnea and chronic physical pain). Alternative moderation and mediation models were conducted but did not support other plausible associations between variables. CONCLUSIONS Waking at night to smoke is likely the result of both nicotine dependence and psychological distress. Given that cotinine levels were not associated with waking at night, the mechanisms of how nicotine dependence may affect waking at night need further investigation.
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Affiliation(s)
- Steven A. Branstetter
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, USA
| | - Nicolle M Krebs
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Science, Milton S. Hershey Medical School, Pennsylvania State University, University Park, PA, USA
| | - Joshua E. Muscat
- Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Science, Milton S. Hershey Medical School, Pennsylvania State University, University Park, PA, USA
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12
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Hovanec J, Weiß T, Koch HM, Pesch B, Behrens T, Kendzia B, Arendt M, Dragano N, Moebus S, Schmidt B, Brüning T, Jöckel KH. Smoking intensity and urinary nicotine metabolites by socioeconomic status in the Heinz Nixdorf Recall study. BMC Public Health 2022; 22:302. [PMID: 35164711 PMCID: PMC8842804 DOI: 10.1186/s12889-022-12609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background Smoking intensity, which is generally based on self-reported average cigarettes per day (CPD), is a major behavioural risk factor and strongly related to socioeconomic status (SES). To assess the validity of the CPD measure, correlations with objective markers of tobacco smoke exposure – such as urinary nicotine metabolites – were examined. Yet, it remains unclear, whether this correlation is affected by SES, which may indicate imprecise or biased self-reports of smoking intensity.
Methods We investigated the role of SES in the association between CPD and nicotine metabolites in current smokers among the participants of the population-based, prospective Heinz Nixdorf Recall Study. We determined urinary cotinine and additionally trans-3′-hydroxy-cotinine. SES was assessed by the International Socio-Economic Index of occupational status, and education. We calculated correlations (Pearson’s r) between logarithmised CPD and cotinine in subgroups of SES and analysed SES and further predictors of cotinine in multiple linear regression models separately by gender. Results Median reported smoking intensity was 20 CPD in male and 19 CPD in female smokers. Men showed higher cotinine concentrations (median 3652 μg/L, interquartile range (IQR) 2279–5422 μg/L) than women (3127 μg/L, IQR 1692–4920 μg/L). Logarithmised CPD correlated moderately with cotinine in both, men and women (Pearson’s r 0.4), but correlations were weaker in smokers with lower SES: Pearson’s r for low, intermediate, and high occupational SES was 0.35, 0.39, and 0.48 in men, and 0.28, 0.43, and 0.47 in women, respectively. Logarithmised CPD and urinary creatinine were main predictors of cotinine in multiple regression models, whereas SES showed a weak negative association in women. Results were similar for trans-3′-hydroxy-cotinine. Conclusions Decreasing precision of self-reported CPD was indicated for low SES in men and women. We found no strong evidence for biased self-reports of smoking intensity by SES. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12609-y.
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Affiliation(s)
- Jan Hovanec
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Tobias Weiß
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Holger M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Beate Pesch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Benjamin Kendzia
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marina Arendt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, Germany.,Department of Computer Science, University of Applied Sciences and Arts, Dortmund, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Susanne Moebus
- Institute for Urban Public Health, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, Germany
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13
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Dobbs PD, Branscum P, Cohn AM, Tackett AP, Comiford AL. Pregnant Smokers' Intention to Switch From Cigarettes to E-Cigarettes: A Reasoned Action Approach. Womens Health Issues 2021; 31:540-549. [PMID: 34452825 DOI: 10.1016/j.whi.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study used the reasoned action approach (RAA) to examine 1) factors associated with pregnant smokers' intention to switch from cigarettes to e-cigarettes and 2) the influence that intention to switch had on future expectations to resume cigarette use postpartum. METHODS U.S. pregnant women (N = 267) who reported past 30-day use of cigarettes completed an online cross-sectional survey between November and December 2019. A 30-item scale measured RAA constructs (intention, instrumental attitudes, experiential attitudes, injunctive norms, descriptive norms, perceived autonomy, and perceived capacity). A confirmatory factor analysis confirmed and structural equation modeling tested the RAA constructs' association with intention to switch and the relationship between intention to switch and future expectations to resume smoking after pregnancy. RESULTS The confirmatory factor analysis confirmed the seven-factor measurement model. Structural equation modeling found instrumental attitudes (β = 0.43; p < .001) and descriptive norms (β = 0.53; p < .001) were associated with intention to switch from cigarettes to e-cigarettes. However, there were differences between the constructs' relationships with intention between those who did and did not use e-cigarettes in the past 30 days. Intention to switch was inversely related with future expectations to resume smoking postpartum (β = -0.13; p < .001). CONCLUSIONS This study examined multiple facets of behavioral decision-making that may influence pregnant smokers' intention to switch to e-cigarettes during pregnancy. In this sample, pregnant people who believed switching from cigarettes to e-cigarettes was important and that other smokers commonly switched during pregnancy reported greater intention to switch. Novel theories, such as the RAA, may provide an optimal lens to understand pregnant smokers' behavioral decision-making process as they consider switching from cigarettes to e-cigarettes.
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Affiliation(s)
- Page D Dobbs
- Health, Human Performance and Recreation Department, University of Arkansas, Fayetteville, Arkansas; Health and Exercise Science Department, University of Oklahoma, Norman, Oklahoma.
| | - Paul Branscum
- Department of Kinesiology and Health, Miami University, Oxford, Ohio
| | - Amy M Cohn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Alayna P Tackett
- Keck School of Medicine, University of Southern California, Los Angeles, California
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14
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Abstract
OBJECTIVES The time to first cigarette (TTFC) of the day has been identified as the best single-item indicator of nicotine dependence. However, TTFC has not been extensively used in clinical settings and is not a criterion for tobacco use disorder, perhaps due to a lack of information about TTFC's predictive value. This review provides a synthesis of the accumulating literature on TTFC's relationships with nicotine dependence, identify gaps, and inform future clinical and epidemiologic research of potential uses of TTFC. METHODS A systematic review of the literature was conducted using PubMed, Google Scholar, and Web of Science ISI databases. We identified 16 articles examining the relation between TTFC and negative outcomes associated with high levels of nicotine addiction and Tobacco Use Disorders (eg, high levels of nicotine and toxicant exposure, progressive use over time, failed cessation, head-and-neck cancers). RESULTS Earlier TTFC was consistently associated with greater likelihood of cessation failure and relapse, and higher levels of biomarkers of tobacco exposure. Several of these associations were found among both adult and adolescent smokers, and remained even after accounting for smoking behaviors (eg, cigarettes/day). CONCLUSIONS Earlier TTFC is a key indicator of greater nicotine dependence. Knowledge of a smoker's TTFC may allow clinicians to accurately inform smokers of health risks and assign greater resources during cessation attempts. Smokers may be able to use TTFC to self-select cessation aids and accurately assess their unique smoking-related health risks. TTFC may be a better item than cigarettes/day for accurately quantifying dependence and risk in epidemiologic studies.
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15
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Hobkirk AL, Midya V, Krebs NM, Allen SI, Reinhart L, Sun D, Stennett AL, Muscat JE. Characterizing nicotine exposure among a community sample of non-daily smokers in the United States. BMC Public Health 2021; 21:1025. [PMID: 34059023 PMCID: PMC8165800 DOI: 10.1186/s12889-021-11052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Over one-quarter of all smokers in the United States identify as non-daily smokers and this number is projected to rise. Unlike daily smokers who typically maintain consistent levels of nicotine exposure with regular smoking, non-daily smokers have variable patterns of smoking that likely result in high intraindividual variability in nicotine intake. The current study aimed to characterize the weekly intraindividual variability in cotinine and identify smoking-related predictors in nondaily smokers. Methods An ecological momentary assessment of 60 non-daily smokers ages 24–57 years was conducted over a consecutive 7-day at-home protocol to log each smoking session, assessments of mood and social activity during smoking, and collection of daily saliva samples in a convenience sample from Pennsylvania, USA. Hierarchical linear regression analyses were conducted to determine the effects of smoking characteristics on total cotinine exposure measured by pharmacokinetic area under the curve and the range, maximum, and minimum cotinine values during the week controlling for demographic variables. Results The mean daily cotinine level was 119.2 ng/ml (SD = 168.9) with individual values that ranged from nondetectable to 949.6 ng/ml. Menthol predicted increased total cotinine levels (P < 0.05). Shorter time to the first cigarette of the day predicted significantly higher minimum (P < 0.05), maximum (P < 0.05), and total cotinine values (P < 0.05) after controlling for covariates. Negative emotions and social interactions with others were also significantly associated with higher cotinine metrics. There was no significant effect of the nicotine metabolite ratio. Conclusions Our findings highlight the variability in nicotine exposure across days among non-daily smokers and point to the role of smoking context in nicotine exposure. The findings suggest the need to develop better assessment methods to determine health and dependence risk and personalized cessation interventions for this heterogeneous and growing group of smokers.
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Affiliation(s)
- Andréa L Hobkirk
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA. .,Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
| | - Vishal Midya
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Sophia I Allen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Dongxiao Sun
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Andrea L Stennett
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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16
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Jo SE, Hwang HR, Kim YJ, Lee SY, Lee JG, Yi YH, Cho YH, Tak YJ, Lee SH, Park EJ, Lee Y. Association between Time to First Cigarette and Health-Related Quality of Life of Middle-Aged Male Current Smokers: A Nationwide Representative Study in Korea. Korean J Fam Med 2021; 42:225-231. [PMID: 32746541 PMCID: PMC8164927 DOI: 10.4082/kjfm.19.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/19/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although many studies have demonstrated that the first cigarette in the morning increases the prevalence of smoking-related morbidity, limited studies have examined the impact of time to first cigarette (TTFC) on the health-related quality of life (HRQoL). Thus, we assessed this relationship using nationally-representative data from the Korea National Health and Nutrition Examination Survey VII-1 (2016). METHODS We conducted a cross-sectional study using data from 577 current male smokers aged 30-59 years, after excluding those with a certain disease. Participants were divided into four categories according to TTFC (≤5 min, 6-30 min, 31-60 min, >60 min). HRQoL was measured using self-reported EuroQol-5 (EQ-5D). The relationship between TTFC and EQ-5D index was analyzed using a multivariate-adjusted generalized linear model to assess how HRQoL varies according to TTFC. After adjusting for confounders, a multivariate-adjusted logistic regression analysis was performed to identify which of the five dimensions of the EQ-5D affected the HRQoL according to TTFC. RESULTS The generalized linear analysis indicated that as TTFC decreased (6-30 min, 31-60 min vs. >60 min), the EQ-5D index score decreased significantly (P=0.037). Shorter TTFC (≤5 min vs. >60 min) was associated with higher pain/discomfort (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.39-10.48) and anxiety/depression (OR, 7.58; 95% CI, 1.75-32.88). CONCLUSION Higher nicotine dependence was associated with impaired HRQoL. These results may be used to improve smoking cessation treatment outcomes.
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Affiliation(s)
- Sung Eun Jo
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hye Rim Hwang
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Yeoup Lee
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center, Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Busan Tobacco Control Center, Pusan National University Hospital, Busan, Korea
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Busan Tobacco Control Center, Pusan National University Hospital, Busan, Korea
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center, Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Jin Tak
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Hun Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Busan Tobacco Control Center, Pusan National University Hospital, Busan, Korea
| | - Eun Ju Park
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center, Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youngin Lee
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center, Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Busan Tobacco Control Center, Pusan National University Hospital, Busan, Korea
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17
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Rudasingwa G, Kim Y, Lee C, Lee J, Kim S, Kim S. Comparison of Nicotine Dependence and Biomarker Levels among Traditional Cigarette, Heat-Not-Burn Cigarette, and Liquid E-Cigarette Users: Results from the Think Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4777. [PMID: 33947137 PMCID: PMC8124521 DOI: 10.3390/ijerph18094777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 11/21/2022]
Abstract
This study aimed to compare Korean smokers' smoking-related biomarker levels by tobacco product type, including heat-not-burn cigarettes (HNBC), liquid e-cigarettes (EC), and traditional cigarettes (TC). Nicotine dependence levels were evaluated in Korean adult study participants including TC-, EC-, HNBC-only users and nonsmokers (n = 1586) from March 2019 to July 2019 in Seoul and Cheonan/Asan South Korea using the Fagerström Test Score. Additionally, urine samples (n = 832) were collected for the measurement of urinary nicotine, cotinine, OH-cotinine, NNAL(4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), CYMA(N-acetyl-S-(2-cyanoehtyl)-L-cysteine), or CEMA (2-cyanoethylmercapturic acid) using LC-MS/MS. The median(interquartile range) nicotine dependence level was not different among the three types of smokers, being 3.0 (2.0-5.0) for TC- (n = 726), 3.0 (1.0-4.0) for EC- (n = 316), and 3.0 (2.0-4.0) for HNBC- (n = 377) only users. HNBC-only users presented similar biomarker levels compared to TC-only users, except for NNAL (HNBC: 14.5 (4.0-58.8) pg/mL, TC: 32.0 (4.0-69.6) pg/mL; p = 0.0106) and CEMA (HNBC: 60.4 (10.0-232.0) ng/mL, TC: 166.1 (25.3-532.1) ng/mL; p = 0.0007). TC and HNBC users showed increased urinary cotinine levels as early as the time after the first smoke of the day. EC users' biomarker levels were possibly lower than TC or HNBC users' but higher than those of non-smokers.
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Affiliation(s)
- Guillaume Rudasingwa
- Integrated Research Center of Risk Assessment, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
| | - Yeonjin Kim
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
| | - Cheolmin Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Korea;
| | - Jeomkyu Lee
- Division of Respiratory and Allergy Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health (NIH), Korea Disease Control and Prevention Agency (KDCA), Osong 28159, Korea; (J.L.); (S.K.)
| | - Seunghyun Kim
- Division of Respiratory and Allergy Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health (NIH), Korea Disease Control and Prevention Agency (KDCA), Osong 28159, Korea; (J.L.); (S.K.)
| | - Sungroul Kim
- Integrated Research Center of Risk Assessment, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
- Department of ICT Environmental Health System, Graduate School, Soonchunhyang University, Soonchunhyang-Ro 22, Asan 31538, Korea;
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Gunawan T, Juliano LM. Differences in Smoking Topography and Subjective Responses to Smoking Among African American and White Menthol and Non-Menthol Smokers. Nicotine Tob Res 2021; 22:1718-1725. [PMID: 32391555 DOI: 10.1093/ntr/ntaa079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/04/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION It has been suggested that menthol increases exposure to harmful elements of smoking and makes smoking more rewarding, easier to initiate, and harder to quit. Isolating the direct effects of menthol is challenging as African American (AA) race and menthol preference are highly overlapping. This study evaluated smoking behavior and subjective responses among a balanced sample of AA and white menthol and non-menthol smokers. In addition, smoking topography (ST) was compared to naturalistic smoking (NS) and interactions with menthol and race were explored. AIMS AND METHODS Smokers (N = 100) smoked and rated their preferred brand of cigarettes via ST or NS during two laboratory visits (counterbalanced). RESULTS Controlling for baseline differences among the groups (eg, nicotine dependence), menthol smokers took shorter and smaller puffs and AA smokers took longer puffs, but there were no differences in total puff volume, carbon monoxide, or other ST parameters. Menthol smokers reported greater urge reduction and lower sensory stimulation. The smoking method (ST vs. NS) had no effects on smoking behavior or exposure. Cigarettes smoked via ST were rated stronger. Differences in satisfaction based on the smoking method interacted with race and menthol status. Ratings of aversion differed by race and menthol status. CONCLUSIONS Menthol was not associated with increased smoke exposure or reward (except for urge reduction). ST caused minimal experimental reactivity relative to NS. Additional research that isolates the effects of menthol and examines potential interactive effects with race and other variables is needed to better understand its role in smoking-related health disparities. IMPLICATIONS Menthol and non-menthol smokers differed on some demographic variables and menthol preference was associated with greater nicotine dependence and greater urge reduction after smoking. Menthol was not associated with greater smoke exposure. Future research that investigates the unique risks associated with menthol and examines potential interactive effects with race and other related variables is warranted to better understand the role of menthol in smoking-related health disparities.
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Affiliation(s)
- Tommy Gunawan
- Department of Psychology, American University, Washington, DC
| | - Laura M Juliano
- Department of Psychology, American University, Washington, DC
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19
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Xue W, Lopez-Quintero C, Anthony JC. 'Time to first tobacco cigarette soon after waking' occurs more often among underage newly incident smokers in the United States, 2004-2017. Addict Behav 2020; 111:106535. [PMID: 32712495 DOI: 10.1016/j.addbeh.2020.106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
AIMS Time to first cigarette (TTFC) after waking is a highly regarded and readily measured manifestation of a tobacco dependence process. We aim to estimate short TTFC as it occurs very soon after the onset of cigarette smoking (CS) in a community sample of newly incident smokers, all 12-21 years of age, and to study risk variation with the age of CS onset. METHODS United States National Surveys on Drug Use and Health, 2004-2017, drew large nationally representative samples of 12-to-21-year-old community residents, and used computerized self-interviews to measure tobacco cigarette smoking, the Fagerstrom TTFC construct, and related variables. A 'short' TTFC was defined as smoking the first cigarette after waking up within 30 min vs. 'long' TTFC or smoking more than 30 min. We studied 8188 newly incident smokers, all assessed within six months after the first puff. Estimated age-specific cumulative incidence proportions (CIP) and odds ratios (OR) are estimated and compared, with due attention to complex survey design and weights. RESULTS Among underage newly incident smokers (12-17 years old), an estimated 5.2% experienced short TTFC within 6 months after CS onset (95% CI = 4.4%, 6.2%), versus 3.7% for older new smokers (18-21 years; 95% CI = 2.8%, 4.6%). Underage smokers are 1.5 times more likely to develop short TTFC compared to older initiates (95% CI = 1.1, 2.1). No male-female variations are seen, but exploratory analysis disclosed findings that involve Census-defined race-ethnicity subgroups. Non-Hispanic African-American initiates are twice as likely to develop short TTFC, and Hispanic initiates are less likely to develop short TTFC, as compared with non-Hispanic White smokers. CONCLUSIONS Based on US community samples our study offers new evidence about TTFC formation observed within six months after the first puff when cigarette smoking starts before age 18 years.
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Affiliation(s)
- Wei Xue
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA; Department of Biostatistics, University of Florida, Gainesville, FL, USA.
| | | | - James C Anthony
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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20
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Conlon MSC, Santi SA, Meigs ML, Davidson SM, Saunders D. Cigarette-smoking characteristics and interest in cessation in patients with head-and-neck cancer. Curr Oncol 2020; 27:e478-e485. [PMID: 33173387 PMCID: PMC7606046 DOI: 10.3747/co.27.6019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Many patients diagnosed with head-and-neck cancer are current or former smokers. Despite the well-known adverse effects of smoking, continuation of smoking during cancer treatment is associated with reduced efficacy of that treatment and with cancer recurrence. In the present study, we examined smoking characteristics in patients with head-and-neck cancer near the time of cancer treatment. Methods A prospective cohort of patients with head-and-neck cancer who attended a dental oncology clinic before receiving cancer treatment at a regional cancer centre were invited to participate in a study that involved completing an interviewer-administered questionnaire to assess smoking characteristics, intention to quit, motivation to quit, and strategies perceived to potentially aid in successful cessation. Results The study enrolled 493 ever-smokers, with a response rate of 96.1% and a self-reported current smoker rate of 37.1% (n = 183). Most of the current smokers reported high nicotine dependence, with 84.7% (n = 155) indicating a time to first cigarette of 30 minutes or less. Most had previously attempted to quit smoking (77.0%), and many had prior unsuccessful quit attempts before resuming smoking again. Most were interested in quitting smoking (85.8%), and many (70.5%) were seriously considering quitting smoking within the subsequent 30 days. Conclusions Patients with head-and-neck cancer reported high nicotine dependence and high interest in cessation opportunities near the time of treatment for cancer. Those results might provide support for provision of smoking cessation opportunities.
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Affiliation(s)
- M S C Conlon
- Health Sciences North Research Institute, Sudbury, ON
- Northeast Cancer Centre, Health Sciences North, Sudbury, ON
- Laurentian University, Sudbury, ON
| | - S A Santi
- Health Sciences North Research Institute, Sudbury, ON
| | - M L Meigs
- Health Sciences North Research Institute, Sudbury, ON
| | - S M Davidson
- Northeast Cancer Centre, Health Sciences North, Sudbury, ON
- Northern Ontario School of Medicine, Sudbury, ON
| | - D Saunders
- Northeast Cancer Centre, Health Sciences North, Sudbury, ON
- Northern Ontario School of Medicine, Sudbury, ON
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21
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Bainter T, Selya AS, Oancea SC. A key indicator of nicotine dependence is associated with greater depression symptoms, after accounting for smoking behavior. PLoS One 2020; 15:e0233656. [PMID: 32442211 PMCID: PMC7244154 DOI: 10.1371/journal.pone.0233656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/09/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Depression is a global burden that is exacerbated by smoking. The association between depression and chronic smoking is well-known; however, existing findings contain possible confounding between nicotine dependence (ND), a latent construct measuring addiction, and objective smoking behavior. The current study examines the possible unique role of ND in explaining depression, independently of smoking behavior. METHODS A nationally-representative sample of current adult daily smokers was drawn by pooling three independent, cross-sectional, biennial waves (spanning 2011-16) of the National Health and Nutrition Examination Survey (NHANES). The association between ND (operationally defined as time to first cigarette (TTFC) after waking) and the amount of depression symptoms was examined after adjusting for both current and lifetime smoking behaviors (cigarettes per day and years of smoking duration) and sociodemographic factors (gender, age, race, education and income to poverty ratio). RESULTS Earlier TTFC was associated with more depression symptoms, such that those smoking within 5 minutes of waking had an approximately 1.6-fold higher depression score (PRR = 1.576, 95% CI = 1.324-1.687) relative to those who smoke more than 1 hour after waking. This relationship remained significant after adjusting for current and lifetime smoking behavior as well as sociodemographic factors (PRR = 1.370, 95% CI = 1.113, 1.687). CONCLUSIONS The latent construct of ND, as assessed by TTFC, may be associated with an additional risk for depression symptoms, beyond that conveyed by smoking behavior alone. This finding can be used for more refined risk prediction for depression among smokers.
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Affiliation(s)
- Tiffany Bainter
- Department of Population Health, Master of Public Health Program, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States of America
| | - Arielle S. Selya
- Department of Population Health, Master of Public Health Program, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States of America
- Behavioral Sciences Group, Sanford Research, Sioux Falls, SD, United States of America
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States of America
| | - S. Cristina Oancea
- Department of Population Health, Master of Public Health Program, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States of America
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22
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Comiford AL, Rhoades DA, Dvorak JD, Ding K, Mehta T, Spicer P, Wagener T, Doescher MP. Use of Potentially Reduced Exposure Tobacco Products Among American Indian Smokeless Tobacco Users: Associations With Cessation Behaviors and Cotinine Levels. Public Health Rep 2020; 135:141-149. [PMID: 31835016 DOI: 10.1177/0033354919893031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES American Indian/Alaska Native (AI/AN) adults use smokeless tobacco products (eg, chewing and dip tobacco) more often than other racial/ethnic groups do. Although US adults increasingly use potentially reduced exposure tobacco products (PREPs), such as electronic cigarettes and snus, no studies have examined the use of PREPs among AI/AN smokeless tobacco users. We examined associations between current PREPs use and smokeless tobacco-related measures, including cessation attempts and cotinine levels, in a sample of American Indian adults who currently use smokeless tobacco. METHODS We collected survey and tobacco biomarker data from 299 adult American Indian smokeless tobacco users at Cherokee Nation health care facilities and events in 2016 and 2017. We used multivariable analyses to determine associations between current PREPs use and smokeless tobacco-related characteristics. RESULTS Current PREPs users were younger, less likely to be married or living with a partner, less likely to report a chronic medical condition, and more likely to report other tobacco use than PREPs nonusers. Among participants with annual household incomes ≤$30 000, current PREPs users were less likely than PREPs nonusers to report a definite desire to quit smokeless tobacco (P = .02). PREPs use was not associated with planning to quit smokeless tobacco, past 12-month smokeless tobacco quit attempts, amount of smokeless tobacco used per week, cotinine levels, or scores on the Fagerström Test for Nicotine Dependence-Smokeless Tobacco. CONCLUSIONS Our study suggests that American Indian smokeless tobacco users may not be using PREPs as a smokeless tobacco cessation aid. Future studies should take this finding into consideration when evaluating the role of PREPs use in smokeless tobacco cessation and in total tobacco cessation in this population.
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Affiliation(s)
- Ashley L Comiford
- Department of Community Health Promotions, Cherokee Nation, Tahlequah, OK, USA
| | - Dorothy A Rhoades
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Justin D Dvorak
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kai Ding
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Toral Mehta
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Columbus OH, USA
| | - Paul Spicer
- Department of Anthropology and Center for Applied Social Research, University of Oklahoma, Norman, OK, USA
| | - Theodore Wagener
- Center for Tobacco Research and Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark P Doescher
- Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Columbus OH, USA.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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23
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Cohn AM, Rose SW, Ilakkuvan V, Gray T, Curry L, Villanti AC, Mays D, Lindblom E, Tercyak K, Debnam C, Mayo A, Perreras L. Harm Perceptions of Menthol and Nonmenthol Cigarettes Differ by Brand, Race/Ethnicity, and Gender in US Adult Smokers: Results from PATH Wave 1. Nicotine Tob Res 2020; 21:439-449. [PMID: 29385527 DOI: 10.1093/ntr/ntx277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/05/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Harm perceptions of menthol cigarettes may contribute to their appeal and use. African-Americans, women, and younger smokers disproportionately use menthol cigarettes, and may misperceive harm of menthol cigarettes. METHODS Data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses of current adult smokers (18 and older) were used to estimate the correlates of menthol smoking among all cigarette brands and separately for the top three cigarette brands (Newport, Camel, and Marlboro). Adjusted models examined the main effect of menthol smoking on harm perceptions of one's own brand of cigarette and interactions with race/ethnicity, age, and gender. RESULTS Menthol cigarettes were used by nearly 40% of current smokers, although the prevalence of menthol smoking differed across the top three brands (94% Newport, 46% Camel, and 18% Marlboro). Among menthol smokers, 80% perceived their cigarette as equally harmful, 14% perceived their brand as more harmful, and 7% perceived their brand as less harmful. In adjusted models, menthol smokers were more likely than nonmenthol smokers to misperceive their own brand as more harmful than other brands (compared to no difference in harm). Race and gender emerged as moderators of the association between menthol brand preference and harm perceptions. CONCLUSIONS In adjusted analyses, menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful than other brands, with differences by sub-groups who disproportionately use menthol. IMPLICATIONS Menthol cigarettes have been historically marketed with messages conveying lower harm than other cigarettes. Little is known about how contemporary adult menthol smokers perceive the harm of their usual brand, and potential differences by race, gender, and young adult versus older adult age group. After adjusting for other factors, menthol smokers were more likely than nonmenthol smokers to perceive their cigarette brand as more harmful than other brands. Further, the association between menthol smoking and harm perceptions differed by race and gender, but not by age group (young adult vs. older adult). This type of large-scale study identifies critical links between menthol smoking and harm perceptions among vulnerable smokers that will inform regulatory actions designed to decrease smoking-related harm.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, VA.,Department of Oncology, Georgetown University Medical Center; Washington, DC, USA
| | | | - Vinu Ilakkuvan
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Tiffany Gray
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Laurel Curry
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center; Washington, DC, USA
| | - Eric Lindblom
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Kenneth Tercyak
- Department of Oncology, Georgetown University Medical Center; Washington, DC, USA
| | | | - Ashley Mayo
- Schroeder Institute at Truth Initiative, Washington, DC
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Branstetter SA, Nye RT, Muscat JE. Time to first cigarette of the day and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in adult regular and non-daily smokers: (NHANES) 2007-10. Regul Toxicol Pharmacol 2019; 108:104454. [PMID: 31470076 DOI: 10.1016/j.yrtph.2019.104454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/21/2022]
Abstract
As the number of regular smokers has decreased over the last decade, the prevalence of light (<10 cigarettes per day) and non-daily smokers has increased. As the FDA continues to develop regulations for tobacco products, understanding factors related to toxin exposure in all smokers is essential. The present study evaluated the relation between the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), as measured by its metabolite, and patterns of heavy smoking (>10 cigarettes per day), light smoking and non-daily smoking and the time to the first cigarette of the day (TTFC), a robust predictor of nicotine addiction, cessation failure, sleep disruption and other health indicators. Findings from a sample of 352 smokers suggest that among intermittent, non-daily and light daily smokers, TTFC of the day was associated with higher levels of NNK metabolite, an effect which was mediated by urinary cotinine levels, but not by the number of cigarettes smoked per day. This suggests these groups of smokers may be puffing each cigarette more intensely, thus increasing nicotine and toxin exposure, despite fewer overall cigarettes. These findings provide further information regarding toxicant exposure associated with lower-frequency smoking and has implications for future regulatory research approaches with lowered nicotine cigarettes and other tobacco products.
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Affiliation(s)
- Steven A Branstetter
- Department of Biobehavioral Health, Pennsylvania State University, 219 BBH Bldg., University Park, PA, 16802, USA.
| | - Russell T Nye
- Department of Biobehavioral Health, Pennsylvania State University, 219 BBH Bldg., University Park, PA, 16802, USA.
| | - Joshua E Muscat
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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25
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Courvoisier D, Walls TA, Cheval B, Hedeker D. A mixed-effects location scale model for time-to-event data: A smoking behavior application. Addict Behav 2019; 94:42-49. [PMID: 30181016 DOI: 10.1016/j.addbeh.2018.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
In general, mixed-effects location scale models (MELS) allow assessment of within-person and between-person variability with time-to-event data for outcomes that follow a normal or ordinal distribution. In this article, we extend the mixed-effects location scale model to time-to-event data in relation to smoking data. Better understanding of the time-graded within-person variability of factors involved in nicotine dependence can be helpful to researchers in their efforts to fine-tune smoking cessation programs. We illustrate the MELS model with data on time to first cigarette measured every day for 7 days in smokers randomized to two groups: a) those asked to keep smoking, or b) those asked to stop. Our results show that some individuals remain very stable in their time to first cigarette over the week, while others show variable patterns. The stable individuals smoked every day, did not smoke immediately upon waking, and were all in the group asked to keep smoking. Conversely, the variable individuals had at least one day during which they did not smoke, other days during which they smoked within the first 5 min of waking, and they were almost all in the group asked to quit smoking. These findings suggested that MELS have the potential to provide insights on how people try to stop smoking. More importantly, this model can be applied to other clinically important outcomes such as time to relapse in a range of cessation programs.
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26
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St Helen G, Benowitz NL, Ahluwalia JS, Tyndale RF, Addo N, Gregorich SE, Pérez-Stable EJ, Cox LS. Black Light Smokers: How Nicotine Intake and Carcinogen Exposure Differ Across Various Biobehavioral Factors. J Natl Med Assoc 2019; 111:509-520. [PMID: 31084916 DOI: 10.1016/j.jnma.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/07/2019] [Accepted: 04/11/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The study objective was to identify biobehavioral variables associated with greater intake of nicotine and a tobacco carcinogen among Black light smokers who smoke 1 to 10 cigarettes per day (CPD). METHODS We analyzed baseline data collected from 426 Black light smokers enrolled in Kick It at Swope III (KIS III), a smoking cessation trial for Black smokers. We examined differences in concentrations of tobacco biomarkers, including urinary total nicotine equivalents (TNE) and total 4-(methylnitrosamino)-1-(3)pyridyl-1-butanonol (NNAL; a human carcinogen), across gender, age, plasma nicotine metabolite ratio (NMR), CPD, and measures of tobacco dependence, including time to first cigarette (TFC), using ANOVA. RESULTS Tobacco biomarker levels were significantly higher among those who smoked more CPD (6-10 vs 1-5 CPD) and those with greater reported physical dependence on tobacco. Concurrently, those who smoked 1-5 CPD smoked each cigarette more intensely than those who smoked 6-10 CPD. While we found no gender differences overall, among those who smoked 1-5 CPD, women had higher NNAL levels compared to men. The rate of nicotine metabolism, measured by the nicotine metabolite ratio, was not significantly related to TNE or NNAL levels. CONCLUSION Among Black Light smokers, higher cigarette consumption and greater physical dependence-but not rate of nicotine metabolism, menthol use, or socioeconomic status-were associated with greater toxicant exposure and thus a likely increased risk of tobacco-related diseases. The lack of data on light smokers, and specifically on Blacks, make this observation important given the disproportionate burden of lung cancer in this population.
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Affiliation(s)
- Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA.
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA; Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Jasjit S Ahluwalia
- Departments of Behavioral and Social Sciences and Medicine, Brown University School of Public Health and Alpert School of Medicine, Providence, RI, USA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute and Addictions Division, Centre for Addiction and Mental Health (CAMH), Department of Pharmacology and Toxicology, Department of Psychiatry, University of Toronto, ON, Canada
| | - Newton Addo
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute and Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, MD, USA
| | - Lisa Sanderson Cox
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
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27
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Ward RC, Tanner NT, Silvestri GA, Gebregziabher M. Impact of Tobacco Dependence in Risk Prediction Models for Lung Cancer Diagnoses and Deaths. JNCI Cancer Spectr 2019; 3:pkz014. [PMID: 31360896 PMCID: PMC6649730 DOI: 10.1093/jncics/pkz014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/15/2019] [Accepted: 03/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background Stronger nicotine dependence is associated with greater lung cancer incidence and lung cancer death. This study investigates whether including nicotine dependence in risk prediction models for lung cancer incidence and mortality provides any important clinical benefits. Methods Smoking data were used from 14 123 participants in the American College of Radiology Imaging Network arm of the National Lung Screening trial. We added nicotine dependence as the primary exposure in two published lung cancer risk prediction models (Katki-Gu or PLCO-m2012) and compared four results: with no tobacco-dependence measure, with time to first cigarette, with heaviness of smoking index, and with Fagestrom test for nicotine dependence. We used a cross-validation method based on leave-one-out and compared performance using likelihood ratio tests (LRT), area under the curve, concordance, sensitivity and specificity for 1% and 2% risk thresholds, and net benefit statistics. Statistical tests were two-sided. Results All LRT results were statistically significant (P ≤ .0001), whereas other tests were not, except that specificity statistically significantly improved (P < .0001). Because the LRT is asymptotically more powerful for testing for prediction gain, we conclude that both models were improved on a statistical level by adding dependence measures. The other performance statistics generally indicated that such gains were likely very small. Net benefit analysis confirmed there was no apparent clinical benefit for including dependence measures. Conclusions Although inclusion of dependence measures may not provide a clinical benefit when added to risk prediction models, nicotine-dependence measures should nonetheless be an integral tool for patient counseling and for encouraging tobacco cessation.
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Affiliation(s)
| | - Nichole T Tanner
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC
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28
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Chen A, Machiorlatti M, Krebs NM, Muscat JE. Socioeconomic differences in nicotine exposure and dependence in adult daily smokers. BMC Public Health 2019; 19:375. [PMID: 30943945 PMCID: PMC6448228 DOI: 10.1186/s12889-019-6694-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/22/2019] [Indexed: 02/04/2023] Open
Abstract
Background Socioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence. Methods The Pennsylvania Adult Smoking Study is a cross-sectional study of smoke exposure and nicotine dependence among adults conducted in central Pennsylvania between June 2012 and April 2014. The study included several measures of SES, including assessments of education and household income, as well as occupation, home ownership, health insurance, household density and savings accounts. Measurements included saliva for the nicotine metabolites cotinine (COT), 3-‘hydroxycotinine (3HC) and total metabolites (COT +3HC). Puffing behavior was determined using portable smoking topography devices. Results The income levels of lighter smokers (< 20 cigarettes per day) was $10,000 more than heavier smokers. Higher Fagerström Test for Nicotine Dependence scores were associated with lower income and job status, scores ranged from 5.4 in unemployed, 4.4 in blue-collar, and 3.8 in white-collar workers. In principal components analysis used to derive SES indicators, household income, number in household, and type of dwelling were the major SES correlates of the primary component. Job category was the major correlate of the second component. Lower SES predicted significantly higher adjusted total nicotine metabolite levels in the unemployed group. Job category was significantly associated with total daily puffs, with the highest level in the unemployed, followed by blue-collar workers, after adjustment for income. Conclusions Among smokers, there was a relationship between lower SES and increased nicotine dependence, cigarettes per day and nicotine exposure, which varied by job type. Electronic supplementary material The online version of this article (10.1186/s12889-019-6694-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allshine Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street CHB309, Box 26901, Oklahoma City, OK, 73104, USA
| | - Michael Machiorlatti
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street CHB309, Box 26901, Oklahoma City, OK, 73104, USA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Dr. CH69, Hershey, PA, 17033, USA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Dr. CH69, Hershey, PA, 17033, USA.
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Sung B. Time to First Cigarette and Self-Reported Health Among US Adult Smokers. Tob Use Insights 2019; 12:1179173X18825262. [PMID: 30728728 PMCID: PMC6351964 DOI: 10.1177/1179173x18825262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.
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Affiliation(s)
- Baksun Sung
- Department of Sociology, Social Work, and Anthropology, Utah State University, Logan, UT, USA
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30
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Zhu J, Nelson K, Toth J, Muscat JE. Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial. BMC Public Health 2019; 19:103. [PMID: 30669994 PMCID: PMC6343324 DOI: 10.1186/s12889-019-6419-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background Atherosclerosis and COPD are systemic inflammatory diseases that share common risk factors including cigarette smoking. A high level of nicotine dependence is emerging as a recently identified risk factor for pulmonary impairment, chronic obstructive pulmonary disease and tobacco-related cancers. We hypothesized that nicotine dependence is associated with the risk of atherosclerosis in long-term cigarette smokers. Methods A nested case-control study was conducted within the National Lung Cancer Screening Trial- American College of Radiology Imaging Network. Cases were defined as having a new diagnosis of any type of atherosclerosis. Controls were matched on a 2:1 basis by age, sex, race, study center, smoking status, years of smoking, and frequency of smoking. Dependence was measured by the time to first cigarette after awakening (TTFC). Results The study included 166 cases and 286 controls. Compared to participants who smoked within 5 min after waking, the risk of atherosclerosis for participants who smoked an hour or more after waking was borderline non-significant (odds ratio = 0.49, 95% confidence intervals [CI] 0.23, 1.00). Findings were similar for men and women. For aortic atherosclerosis, the corresponding odds ratio was 0.24 (95% CI 0.08, 0.69). Hypertension was associated with an increased risk and body mass index was associated with a decreased risk of aortic atherosclerosis. The TTFC was unrelated to coronary atherosclerosis. Conclusions Compared to smoking immediately after waking, delaying an hour or more reduces the risk of aortic atherosclerosis even among long-term heavy smokers. Possible mechanisms that explain this association are intensity of smoking, inflammation and oxidative stress, and elevated lipid levels.
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Affiliation(s)
- Junjia Zhu
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Kevin Nelson
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Jennifer Toth
- Penn State Milton S. Hershey Medical Center, Department of Pulmonary Medicine, 500 University Drive, PO Box 850, Hershey, PA, 17033, USA
| | - Joshua E Muscat
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA.
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Pechacek TF, Nayak P, Slovic P, Weaver SR, Huang J, Eriksen MP. Reassessing the importance of 'lost pleasure' associated with smoking cessation: implications for social welfare and policy. Tob Control 2018; 27:e143-e151. [PMID: 29183920 PMCID: PMC6176518 DOI: 10.1136/tobaccocontrol-2017-053734] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Benefit-cost analyses of tobacco regulations include estimates of the informed choice of smokers to continue smoking. Few studies have focused on subjective feelings associated with continued smoking. This study estimates how smoker discontent and regret relate to risk perceptions and health concerns. METHODS We analysed data from a 2015 nationally representative, online survey of 1284 US adult current smokers. Information was collected on regret, intention to quit, perceived addiction, risk perceptions and health concerns. Multivariate logistic regression adjusting for sociodemographics and health status was used to examine factors associated with smoker discontent. RESULTS More than 80% of current smokers report high (22.5%) or very high (59.8%) discontent due to inability to quit, perceived addiction and regret about having started to smoke. Higher levels of discontent did not vary significantly by sex, age, race/ethnicity, education or income (adjusted odds ratios (AORs) 0.5-1.2). Compared with the smokers expressing low (5.9%) or very low (3.6%) discontent, those expressing higher levels of discontent perceived their health status as fair/poor (AOR=2.3), worried most of the time about lung cancer (AOR=4.6) and felt they were more likely to develop lung cancer in the future (AOR=5.1). CONCLUSION The proportion of smokers who might be characterised as having a preference to continue smoking are greatly outnumbered by addicted, discontent and concerned smokers who want to quit and regret ever having started to smoke. These discontent smokers could have a substantial net welfare gain if new regulations helped them escape their concerns about the health effects from continuing smoking.
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Affiliation(s)
- Terry Frank Pechacek
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
| | - Pratibha Nayak
- Public Health Research & Translational Science, Battelle Memorial Institute, Atlanta, Georgia, USA
| | | | - Scott R Weaver
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, Georgia, USA
| | - Jidong Huang
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
| | - Michael P Eriksen
- Georgia State University's Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
- Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
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King G, Moolchan ET, Bendel RB, Yerger VB. Tanning Capacity and Nicotine Dependence Among African Americans. J Natl Med Assoc 2018; 110:358-366. [PMID: 30126561 DOI: 10.1016/j.jnma.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Recent findings suggest a link between facultative melanin and nicotine dependence among African Americans. We hypothesized that tanning capacity is associated with the time to first cigarette (TTFC) of the day. METHODS Using a criterion based sample of 150 adult African American current smokers, reflectometer measures of constitutive and facultative melanin, tanning capacity, smoking status and history, saliva cotinine, sociodemographic characteristics, and stress and discrimination scales were recorded. TTFC was categorized as: 1) within the first 5 min versus more than 5 min; and 2) within the first 30 min versus more than 30 min. Descriptive and multivariate analyses were conducted. RESULTS Analysis revealed significantly higher tanning capacity among individuals who smoked their first cigarette of the day within the first 5 min of awakening (13.5) than among those who smoked after 5 min (10.3, p = 0.01) and among those who smoked within the first 30 min (12.8 vs. 9.6, p = 0.03) compared to those who initiated after this time point. Multivariate logistic regression indicated that tanning capacity was significantly and positively related (OR = 1.14, 95% CI = 1.05-1.22) to TTFC within the first 5 min and was also significantly related to TTFC within the first 30 min (OR = 1.13, CI = 1.03-1.23). CONCLUSION Tanning capacity was positively associated with a behavioral measure of nicotine dependence among African American smokers. This association was consistent whether comparing smokers at higher or lower levels of dependence. Future research should examine tanning capacity and other indicators of melanin content with smoking cessation rates and tobacco-attributable health disparities.
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Affiliation(s)
- Gary King
- Department of Behavioral Health, Pennsylvania State University, State College, PA, USA.
| | | | - Robert B Bendel
- School of Nursing, Washington State University, Spokane, WA, USA
| | - Valerie B Yerger
- Department of Social & Behavioral Sciences, University of California at San Francisco, San Francisco, CA, USA
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Tobacco Dependence Predicts Higher Lung Cancer and Mortality Rates and Lower Rates of Smoking Cessation in the National Lung Screening Trial. Chest 2018; 154:110-118. [PMID: 29793736 DOI: 10.1016/j.chest.2018.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/08/2018] [Accepted: 04/02/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Incorporating tobacco treatment within lung cancer screening programs has the potential to influence cessation in high-risk smokers. We aimed to better understand the characteristics of smokers within a screening cohort, correlate those variables with downstream outcomes, and identify predictors of continued smoking. METHODS This study is a secondary analysis of the National Lung Screening Trial randomized clinical study. Tobacco dependence was evaluated by using the Fagerstrӧm Test for Nicotine Dependence, the Heaviness of Smoking Index, and time to first cigarette (TTFC); descriptive statistics were performed. Clinical outcomes (smoking cessation, lung cancer, and mortality) were assessed with descriptive statistics and χ2 tests stratified according to nicotine dependence. Logistic and Cox regression models were used to study the influence of dependence on smoking cessation and mortality, respectively. RESULTS Patients with high dependence scores were less likely to quit smoking compared with low dependence smokers (TTFC OR, 0.50 [95% CI, 0.42-0.60]). Indicators of high dependence, as measured according to all three metrics, were associated with worsening clinical outcomes. TTFC showed that patients who smoked within 5 min of waking (indicating higher dependence) had higher rates of lung cancer (2.07% for > 60 min after waking vs 5.92% ≤ 5 min after waking; hazard ratio [HR], 2.56 [95% CI, 1.49-4.41]), all-cause mortality (5.38% for > 60 min vs 11.21% ≤ 5 min; HR, 2.19 [95% CI, 1.55-3.09]), and lung cancer-specific mortality (0.55% for > 60 min vs 2.92% for ≤ 5 min; HR, 4.46 [95% CI, 1.63-12.21]). CONCLUSIONS Using TTFC, a one-question assessment of tobacco dependence, at the time of lung cancer screening has implications for personalizing tobacco treatment and improving risk assessment.
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Chen A, Krebs NM, Zhu J, Sun D, Stennett A, Muscat JE. Sex/Gender Differences in Cotinine Levels Among Daily Smokers in the Pennsylvania Adult Smoking Study. J Womens Health (Larchmt) 2017; 26:1222-1230. [PMID: 28872928 DOI: 10.1089/jwh.2016.6317] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study was conducted to determine sex/gender differences in smoke exposure and to quantify the role of potential predictors including puffing behaviors, nicotine dependence, and non-nicotinic factors. METHODS The Pennsylvania Adult Smoking Study (PASS) of 332 adult cigarette smokers utilized portable handheld topography devices to capture the smokers' profiles in a naturalistic environment. Sex/gender differences in salivary biomarkers were modeled using ANCOVA to account for measures of dependence (Fagerstrom Test for Nicotine Dependence, nicotine metabolite ratio [3-hydroxycotinine/cotinine]), and nondependence covariates including anthropomorphic factors and stress. The Blinder-Oaxaca method was used to decompose the sex/gender differences in nicotine uptake due to covariates. RESULTS Men had significantly higher cotinine levels (313.5 ng/mL vs. 255.8 ng/mL, p < 0.01), cotinine +3-hydroxycotinine levels, (0.0787 mol/L vs. 0.0675 mol/L, p = 0.01), puff volumes (52.95 mL vs. 44.77 mL, p < 0.01), and a lower nicotine metabolite ratio (0.396 vs. 0.475, p = 0.01) than women. The mean Fagerström Test for Nicotine Dependence score did not differ between men and women (p = 0.24). Women had a higher mean Hooked on Tobacco Checklist score than men (7.64 vs. 6.87, p < 0.01). In multivariate analysis, nicotine metabolite levels were not significantly different by sex. Decomposition results show that ten predictors can explain 83% of the sex/gender differences in cotinine uptake. Height was the greatest contributor to these differences, followed by average puff volume. Conclusion and Impact: The higher levels of nicotine metabolites in men, compared to women, can be explained by height, weight, puff volume, and nicotine metabolism.
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Affiliation(s)
- Allshine Chen
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Nicolle M Krebs
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Junjia Zhu
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Dongxiao Sun
- 2 Department of Pharmacology, Penn State University , Hershey, Pennsylvania
| | - Andrea Stennett
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Joshua E Muscat
- 1 Department of Public Health Sciences, Penn State University College of Medicine , Hershey, Pennsylvania
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Steinberg ML, Stahl NF, Williams JM. Household Smoking Restrictions Relate To Time To First Cigarette Smoked In The Morning. J Smok Cessat 2017; 12:1-5. [PMID: 38572325 PMCID: PMC10989735 DOI: 10.1017/jsc.2015.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction The time a smoker waits until the first cigarette of the morning is often used as a measure of dependence with the rationale that more dependent smokers will smoke sooner upon waking than will less dependent smokers after going several hours without a cigarette overnight. Aims We sought to examine the relationship between time-to-first-cigarette (TTFC) and household smoking restrictions in two independent samples. Methods Two samples of smokers, one treatment-seeking community sample (N = 433) and one non-treatment-seeking sample of smokers with serious mental illness (i.e., Schizophrenia, Schizoaffective Disorder, or Bipolar I Disorder) (N = 94), provided information on cigarette dependence with the Fagerström Test for Nicotine Dependence and on household smoking restrictions. Results Half (50%) of smokers with serious mental illness and 36.7% of smokers from the general population reported that there were no limitations to smoking in their home. Household smoking restrictions were significantly and positively related to TTFC in both samples. Conclusions These data indicate that greater attention to TTFC may be warranted. The TTFC item is intended to measure dependence based on the premise that greater dependence should be associated with shorter TTFC. If TTFC is related to a household smoking ban, however, this item may not be assessing dependence as intended in some cases.
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Affiliation(s)
- Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Naomi F Stahl
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jill M Williams
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Jiang N, Ho SY, Wang MP, Leung LT, Lam TH. The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents. Addict Behav 2017; 64:123-128. [PMID: 27608324 DOI: 10.1016/j.addbeh.2016.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/14/2016] [Accepted: 08/29/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. METHODS We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7-12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days. RESULTS Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61-7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00-2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35-3.19). CONCLUSIONS Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.
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Affiliation(s)
- Nan Jiang
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong.
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Van Overmeire IP, De Smedt T, Dendale P, Nackaerts K, Vanacker H, Vanoeteren JF, Van Laethem DM, Van Loco J, De Cremer KA. Nicotine Dependence and Urinary Nicotine, Cotinine and Hydroxycotinine Levels in Daily Smokers. Nicotine Tob Res 2016; 18:1813-9. [DOI: 10.1093/ntr/ntw099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/03/2016] [Indexed: 12/25/2022]
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Nollen NL, Ahluwalia JS, Lei Y, Yu Q, Scheuermann TS, Mayo MS. Adult Cigarette Smokers at Highest Risk for Concurrent Alternative Tobacco Product Use Among a Racially/Ethnically and Socioeconomically Diverse Sample. Nicotine Tob Res 2016; 18:386-94. [PMID: 25999383 PMCID: PMC6220834 DOI: 10.1093/ntr/ntv110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 05/12/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Rates of alternative tobacco product use (ATPs; eg, cigars, cigarillos, pipes) among cigarette smokers are on the rise but little is known about the subgroups at highest risk. This study explored interactions between demographic, tobacco, and psychosocial factors to identify cigarette smokers at highest risk for ATP use from a racially/ethnically and socioeconomically diverse sample of adult smokers across the full smoking spectrum (nondaily, daily light, daily heavy). METHODS Two-thousand three-hundred seventy-six adult cigarette smokers participated in an online cross-sectional survey. Quotas ensured equal recruitment of African American (AA), white (W), Hispanic/Latino (H) as well as daily and nondaily smokers. Classification and Regression Tree modeling was used to identify subgroups of cigarette smokers at highest risk for ATP use. RESULTS 51.3% were Cig+ATP smokers. Alcohol for men and age, race/ethnicity, and discrimination for women increased the probability of ATP use. Strikingly, 73.5% of men screening positive for moderate to heavy drinking and 62.2% of younger (≤45 years) African American/Hispanic/Latino women who experienced regular discrimination were Cig+ATP smokers. CONCLUSIONS Screening for concurrent ATP use is necessary for the continued success of tobacco cessation efforts especially among male alcohol users and racial/ethnic minority women who are at greatest risk for ATP use.
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Affiliation(s)
- Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS;
| | - Jasjit S Ahluwalia
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Yang Lei
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS
| | - Qing Yu
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS
| | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS
| | - Matthew S Mayo
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS
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McCarthy DE, Bold KW, Minami H, Yeh VM. A randomized clinical trial of a tailored behavioral smoking cessation preparation program. Behav Res Ther 2016; 78:19-29. [PMID: 26827293 PMCID: PMC4790439 DOI: 10.1016/j.brat.2015.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
Despite considerable progress in reducing cigarette smoking prevalence and enhancing smoking cessation treatments, most smokers who attempt to quit relapse. The current randomized clinical trial evaluated the efficacy of an adjunctive behavioral smoking cessation treatment based on learning theory. Adult daily smokers were randomly assigned to standard treatment (N = 47) with nicotine patch and individual counseling or to standard treatment plus a "practice quitting" program involving seven sessions of escalating prescribed abstinence periods (N = 46) prior to a target stop smoking date. Practice quitting was designed to extinguish smoking in response to withdrawal symptoms. Retention in treatment was excellent and the treatment manipulation increased the interval between cigarettes across practice quitting sessions on average by 400%. The primary endpoint, seven-day point-prevalence abstinence four weeks post-quit, was not significantly affected by practice quitting (31.9% in the standard treatment condition, 37.0% in the practice quitting condition). Practice quitting increased latency to a first lapse among those who quit smoking for at least one day and prevented progression from a first lapse to relapse (smoking daily for a week) relative to standard treatment, however. Practice quitting is a promising adjunctive treatment in need of refinement to enhance adherence and efficacy.
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Affiliation(s)
- Danielle E McCarthy
- Rutgers, The State University of New Jersey Department of Psychology, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA.
| | - Krysten W Bold
- Rutgers, The State University of New Jersey Department of Psychology, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA.
| | - Haruka Minami
- Rutgers, The State University of New Jersey Department of Psychology, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA.
| | - Vivian M Yeh
- Rutgers, The State University of New Jersey Department of Psychology, Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA.
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Abstract
BACKGROUND Latino smokers are a rising public health concern who experience elevated tobacco-related health disparities. PURPOSE Additional information on Latino smoking is needed to inform screening and treatment. ANALYSIS Latent class analysis using smoking frequency, cigarette preferences, onset, smoking duration, cigarettes per day, and minutes to first cigarette was used to create multivariate latent smoking profiles for Latino men and women. RESULTS Final models found seven classes for Latinas and nine classes for Latinos. Despite a common finding in the literature that Latino smokers are more likely to be low-risk intermittent smokers, the majority of classes for both males and females described patterns of high-risk daily smoking. Gender variations in smoking classes were noted. CONCLUSIONS Several markers of smoking risk were identified among both male and female Latino smokers, including long durations of smoking, daily smoking, and preference for specialty cigarettes, all factors associated with long-term health consequences.
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Affiliation(s)
- Allison N Kristman-Valente
- Social Development Research Group, University of Washington, Box 358734 9725, Third Ave NE, Suite 401, Seattle, WA, 98115, USA.
| | - Brian P Flaherty
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA.
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Mercincavage M, Smyth JM, Branstetter SA, Catley D. Exploring the Severity of Dependence Scale (SDS) as a possible measure of nicotine dependence. Subst Abus 2015; 37:323-9. [PMID: 26566575 DOI: 10.1080/08897077.2015.1062459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The time to first cigarette (TTFC) of the day is an emerging single-item indicator of nicotine dependence due to its robust associations with indices of physical dependence. However, it is unclear if this measure adequately captures other dimensions of dependence. The Severity of Dependence Scale (SDS) is a brief questionnaire used to assess psychological aspects of dependence that has not yet been extensively applied to smoking research. METHODS We examined associations between the SDS and TTFC among 255 smokers during the baseline session of a cessation trial. We also examined associations of the SDS and TTFC with biobehavioral dependence indices, quitting behaviors, and cognitive-affective variables and compared the relative contributions of both measures in predicting these variables. RESULTS TTFC was unrelated to SDS total score, but was related to individual SDS items. TTFC, but not SDS, was correlated with indices of physical dependence (e.g., cigarettes per day [CPD], carbon monoxide [CO]). Both TTFC and SDS were associated with quitting behaviors, with opposite directionality of associations. TTFC and SDS were both associated with cognitive-affective variables, but SDS outperformed TTFC in strength and number of these relationships. Including both the SDS and TTFC as regression model predictors often increased the amount of variance explained. CONCLUSIONS Findings suggest that SDS and TTFC assess different constructs of nicotine dependence; among smokers, the SDS appears to tap into nonphysical components of dependence (e.g., loss of control) that relate to quitting motivation and affect. Assessing nicotine dependence using only the SDS may fail to capture physical dependence and, further, may not reflect the same domains of addiction the SDS assesses in other drugs of abuse. Nonetheless, using 3 SDS items in addition to TTFC may offer utility over using TTFC alone.
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Affiliation(s)
- Melissa Mercincavage
- a Department of Biobehavioral Health , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Joshua M Smyth
- a Department of Biobehavioral Health , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Steven A Branstetter
- a Department of Biobehavioral Health , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Delwyn Catley
- b Department of Psychology , University of Missouri-Kansas City , Kansas City , Missouri , USA
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Lee S, Jang M, Noh HM, Oh HY, Song HJ, Park KH, Paek YJ. Time to First Cigarette and Hypertension in Korean Male Smokers. Korean J Fam Med 2015; 36:221-6. [PMID: 26435812 PMCID: PMC4591387 DOI: 10.4082/kjfm.2015.36.5.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 07/09/2015] [Indexed: 11/30/2022] Open
Abstract
Background Morning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosis Methods We investigated that the relationship between TTFC and blood pressure. The study subjects included male current smokers (n=211) who had health check-up in Hallym University Sacred Heart Hospital from July to September, 2014. We categorized the subjects into 2 groups according to TTFC; early TTFC (TTFC <30 minutes) and late TTFC (TTFC ≥30 minutes), and the subjects who were taking antihypertensive medications or had a high blood pressure (>140 mm Hg or 90 mm Hg) were defined as hypertensive group. Multivariate logistic regression was performed to estimate the odds ratio and 95% confidence interval to investigate the association between TTFC and hypertensive group. Results Compared with late TTFC, early TTFC had higher odds (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.89-7.94) for hypertensive group. After adjusting confounding factors, early TTFC was significantly associated with an increased risk of hypertension (OR, 4.43; 95% CI, 1.84-10.70). Conclusion early TTFC after waking is associated with hypertension. It suggests delaying TTFC might help to control of blood pressure among the current smokers who are not ready to immediately quit smoking.
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Affiliation(s)
- Saerom Lee
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Miae Jang
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hye-Young Oh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Jain R, Jhanjee S, Jain V, Gupta T, Mittal S, Chauhan P, Raghav R, Goelz P, Schnoll RA. Biochemical Validation of Self-Reported Smokeless Tobacco Abstinence among Smokeless Tobacco Users: Results from a Clinical Trial of Varenicline in India. J Psychoactive Drugs 2015; 47:331-5. [PMID: 26317285 DOI: 10.1080/02791072.2015.1073412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The validity of self-reported tobacco use is often questioned given the potential for underestimation of use. This study used data from a double-blind, placebo-controlled clinical trial of varenicline for smokeless tobacco dependence in India to evaluate the accuracy of self-reported smokeless tobacco cessation using biochemical validation procedures and to evaluate correlates of reporting inaccuracy. Smokeless tobacco users attending a dental clinic at AIIMS were randomized to placebo or varenicline; all participants received counseling. Detailed smokeless tobacco use was recorded and abstinence was defined as cotinine-verified 7-day point prevalence cessation (cotinine < 50 ng/ml) and breath CO > 10 ppm at the end of 12 weeks of treatment. One-half of study completers (82/165) self-reported abstinence. Biochemical verification confirmed that (65.9%) subjects provided accurate self-reports while (34.1%) participants underreported tobacco use. These data indicate poor agreement between self-reported and biochemically confirmed abstinence (κ = -0.191). Underreporters of tobacco use had significantly higher baseline cotinine (p < 0.05), total craving (p < 0.012), and negative reinforcement craving (p < 0.001) vs. those whose self-reports were correctly verified. These findings provide evidence to support the need for biochemical validation of self-reported abstinence outcomes among smokeless tobacco users in cessation programs in India and identify high levels of pretreatment cotinine and craving levels as potential correlates of false reporting.
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Affiliation(s)
- Raka Jain
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Sonali Jhanjee
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Veena Jain
- b Centre for Dental Education and Research , All India Institute of Medical Sciences , New Delhi , India
| | - Tina Gupta
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Swati Mittal
- b Centre for Dental Education and Research , All India Institute of Medical Sciences , New Delhi , India
| | - Prashant Chauhan
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Rahul Raghav
- a National Drug Dependence Treatment Centre , All India Institute of Medical Sciences , New Delhi , India
| | - Patricia Goelz
- c Department of Psychiatry and Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA
| | - Robert A Schnoll
- c Department of Psychiatry and Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA
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Social Inequality in Cigarette Consumption, Cigarette Dependence, and Intention to Quit among Norwegian Smokers. BIOMED RESEARCH INTERNATIONAL 2015; 2015:835080. [PMID: 26273648 PMCID: PMC4529928 DOI: 10.1155/2015/835080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/13/2015] [Accepted: 02/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study aim was to examine the influence of education and income on multiple measures of risk of smoking continuation. METHODS Three logistic regression models were run on cigarette consumption, dependence, and intention to quit based on nationally representative samples (2007-2012) of approximately 1 200 current smokers aged 30-66 years in Norway. RESULTS The relative risk ratio for current versus never smokers was RRR 5.37, 95% CI [4.26-6.77] among individuals with low educational level versus high and RRR 1.53, 95% CI [1.14-2.06] in the low-income group versus high (adjusted model). Low educational level was associated with high cigarette consumption, high cigarette dependence, and no intention to quit. The difference in predicted probability for having high cigarette consumption, high cigarette dependence, and no intention to quit were in the range of 10-20 percentage points between smokers with low versus those with high educational level. A significant difference between low- and high-income levels was observed for intention to quit. The effect of education on high consumption and dependence was mainly found in smokers with high income. CONCLUSION Increased effort to combat social differences in smoking behaviour is needed. Implementation of smoking cessation programmes with high reach among low socioeconomic groups is recommended.
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Boehm G, Schroeder Y, Schoberberger R. Inpatient smoking cessation therapy: truth or dare? Wien Klin Wochenschr 2015; 127:786-91. [PMID: 26142170 DOI: 10.1007/s00508-015-0820-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aims to answer the question to which extent even very heavy nicotine-dependent smokers can benefit from a 3-week inpatient smoking cessation program. A particular focus lies on analyzing the positive effects, which go above and beyond normally anticipated health benefits. METHODS This is a descriptive study observing 270 patients over a 1-year period consisting of recruitment, therapy, and two post-therapy follow-up visits at 6-month interval. Gender differences, changes in body weight, and factors relating to addiction and the nicotine withdrawal process are analyzed. In comparing successful participants-post-therapy nonsmokers-with less successful ones, our analysis identifies benefits and advantages an inpatient smoking cessation therapy can bring to even the heaviest smokers. RESULTS At the 12-month post-therapy follow-up visit, 42.6% of participants were identified as nonsmokers. A total of 34.0% of participants took up smoking again. No data is available on the remaining participants. Nonsmokers experienced significant reduction in nicotine craving and withdrawal symptoms. In terms of body weight, increases were found in both, men and women, nonsmokers and smokers. CONCLUSION Successful quitters fail to report of an unbearable strong desire to smoke. Such unfounded fear should be communicated. Weight gain remains an undesired side effect. Hence, it is crucial to diagnose individuals more prone to weight gain and offer coping strategies thus reducing the risk of developing obesity. Nevertheless, the outcome of the study should be an encouragement to also heavy smokers and empower them to undertake smoking cessation.
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Affiliation(s)
- Gabriela Boehm
- Institute of Social Medicine, Center of Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
| | - Yvonne Schroeder
- Department of Finance, Faculty of Business, Economics and Statistics, University of Vienna, Vienna, Austria
| | - Rudolf Schoberberger
- Institute of Social Medicine, Center of Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
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Guertin KA, Gu F, Wacholder S, Freedman ND, Panagiotou OA, Reyes-Guzman C, Caporaso NE. Time to First Morning Cigarette and Risk of Chronic Obstructive Pulmonary Disease: Smokers in the PLCO Cancer Screening Trial. PLoS One 2015; 10:e0125973. [PMID: 25985429 PMCID: PMC4436174 DOI: 10.1371/journal.pone.0125973] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/27/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Time to first cigarette (TTFC) after waking is an indicator of nicotine dependence. The association between TTFC and chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States, has not yet been reported. METHODS We investigated the cross-sectional association between TTFC and prevalent COPD among 6,108 current smokers in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. COPD was defined as a self-reported diagnosis of emphysema, chronic bronchitis, or both. Current smokers in PLCO reported TTFC, the amount of time they typically waited before smoking their first cigarette of the day after waking, in four categories: ≤ 5, 6-30, 31-60, or > 60 minutes. We used logistic regression models to investigate the association between TTFC and prevalent COPD with adjustments for age, gender, race, education, and smoking (cigarettes/day, years smoked during lifetime, pack-years, age at smoking initiation), and prior lung cancer diagnosis. RESULTS COPD was reported by 19% of these 6,108 smokers. Individuals with the shortest TTFC had the greatest risk of COPD; compared to those with the longest TTFC (> 60 minutes) the adjusted odds ratios (OR) and 95% confidence intervals (CI) for COPD were 1.48 (95% CI, 1.15-1.91), 1.64 (95% CI, 1.29-2.08), 2.18 (95% CI, 1.65-2.87) for those with TTFC 31-60 minutes, 6-30 minutes, and ≤ 5 minutes, respectively (P-trend < 0.0001). The association between TTFC and emphysema was similar to that for bronchitis, albeit the ORs were slightly stronger for chronic bronchitis; comparing TTFC ≤5 minutes to > 60 minutes, the adjusted OR (95% CI) was 2.29 (1.69-3.12) for emphysema and 2.99 (1.95-4.59) for chronic bronchitis. CONCLUSIONS Current smokers with shorter TTFC have increased risk of COPD compared to those with longer TTFC, even after comprehensive adjustment for established smoking covariates. Future epidemiologic studies, including prospective designs, should incorporate TTFC to better assess disease risk and evaluate the potential utility of TTFC as a COPD screening tool for smokers in the clinical setting.
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Affiliation(s)
- Kristin A. Guertin
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
- * E-mail: (NEC); (KAG)
| | - Fangyi Gu
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
| | - Sholom Wacholder
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
| | - Neal D. Freedman
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
| | - Orestis A. Panagiotou
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
| | - Carolyn Reyes-Guzman
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
| | - Neil E. Caporaso
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, United States of America
- * E-mail: (NEC); (KAG)
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Branstetter SA, Mercincavage M, Muscat JE. Predictors of the Nicotine Dependence Behavior Time to the First Cigarette in a Multiracial Cohort. Nicotine Tob Res 2014; 17:819-24. [PMID: 25431372 DOI: 10.1093/ntr/ntu236] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND The time to first cigarette of the day (TTFC) is a strong indicator of nicotine dependence behaviors such as nicotine uptake and quit success in young and older smokers. There are substantial differences in levels of nicotine dependence by race and ethnic group. METHODS Data from Wave III of the multiracial National Longitudinal Study of Adolescent Health were analyzed for young smokers between the ages of 21 and 28 (N = 1,425). Time to first cigarette data was compared between Hispanic, White, Black, Native American, and Asian smokers. RESULTS Black smokers were significantly more likely to smoke within 5min of waking than White, Hispanic, and Asian smokers. Lower personal income predicted smoking within 5min of waking for both White and Black smokers. For White smokers, increased number of cigarettes per day and increased years of smoking also predicted smoking within 5min of waking. The number of days smoked or number of cigarettes per day did not predict smoking within 5min of waking among smokers. CONCLUSIONS The higher prevalence of early TTFC among Blacks indicates increased nicotine and carcinogen exposure, and may help explain the increased lung cancer rates and failed cessation attempts among Black smokers. TTFC may be an important screening item, independent of cigarettes per day, for clinicians and interventions to identify those at highest risk for cessation failure and disease risk.
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Affiliation(s)
- Steven A Branstetter
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA;
| | - Melissa Mercincavage
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Lindsay RP, Tsoh JY, Sung HY, Max W. Secondhand smoke exposure and serum cotinine levels among current smokers in the USA. Tob Control 2014; 25:224-31. [PMID: 25398561 DOI: 10.1136/tobaccocontrol-2014-051782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/29/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) likely provides additional exposure to nicotine and toxins for smokers, but has been understudied. Our objective was to determine whether SHS exposure among smokers yields detectable differences in cotinine levels compared with unexposed smokers at the population level. METHODS Using the US National Health and Nutrition Examination Survey (NHANES) for the years 1999-2012, we compared serum cotinine levels of 4547 current adult cigarette smokers stratified by self-reported SHS exposure sources (home and/or work) and smoking intensity. A weighted multivariable linear regression model determined the association between SHS exposure and cotinine levels among smokers. RESULTS Smokers with SHS exposure at home (43.8%) had higher cotinine levels (β=0.483, p≤0.001) compared with those with no SHS exposure at home after controlling for the number of cigarettes smoked per day and number of days smoked in the previous 5 days, survey year, age, gender and education. Smokers with SHS exposure at work (20.0%) did not have significantly higher cotinine levels after adjustment. The adjusted geometric mean cotinine levels of light smokers (1-9 cigarettes per day) with no SHS exposure, exposure at work only, home only, and both home and work were 52.0, 62.7, 67.2, 74.4 ng/mL, respectively, compared with 219.4, 220.9, 255.2, 250.5 ng/mL among moderate/heavy smokers (≥10 cigarettes per day). CONCLUSIONS Smokers living in residences where others smoke inside the home had significantly higher cotinine levels than smokers reporting no SHS exposure, regardless of individual smoking intensity. Future research should target the role that SHS exposure may have in nicotine dependence, cessation outcomes and other health impacts among smokers.
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Affiliation(s)
- Ryan P Lindsay
- Master of Public Health Program, Idaho State University-Meridian Campus, Meridian, Idaho, USA
| | - Janice Y Tsoh
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
| | - Wendy Max
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
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Gu F, Wacholder S, Freedman ND, Panagiotou OA, Reyes-Guzman C, Bertazzi PA, Caporaso NE. Response. J Natl Cancer Inst 2014; 106:dju350. [DOI: 10.1093/jnci/dju350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Rodu B, Plurphanswat N, Fagerström K. Time to First Use Among Daily Smokers and Smokeless Tobacco Users. Nicotine Tob Res 2014; 17:882-5. [PMID: 25358658 DOI: 10.1093/ntr/ntu224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/14/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Time to the first cigarette after waking up in the morning is the most validated measure of dependence among smokers, and its complement is also a good indicator of dependence for smokeless tobacco (ST) users. However, no studies have directly compared these measures. METHODS We used a multivariate logistic regression model to compare the time to first use (TTFU) of cigarettes and ST among white men 18+ years of age who were daily users in the 2003 Tobacco Use Supplement of the Current Population Survey. Smokers were classified as light (1-14 cigarettes per day [cpd]), moderate (15-24 cpd), and heavy (25+ cpd) and ST users were classified as former smokers or exclusive users. RESULTS There was no difference in TTFU within 5min between light smokers and exclusive ST users (Odds ratio [OR] = 1.3, CI = 0.95-1.7), but the latter were less likely to use tobacco within 30min (OR = 0.75, CI = 0.62-0.89). ST former smokers were more likely than light smokers to have a TTFU within 5min (OR = 1.5, CI = 1.1-2.0) but not within 30min. Moderate and heavy smokers had significantly higher odds of TTFU within both time points than light smokers. CONCLUSION Compared to light smokers, the likelihood of TTFU within 5min was similar among exclusive ST users and was slightly higher among ST former smokers, offering some support for the Fagerström-Eissenberg hypothesis that the dependence level of cigarettes is higher than that of ST.
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Affiliation(s)
- Brad Rodu
- Department of Medicine, School of Medicine, University of Louisville, Louisville, KY; James Graham Brown Cancer Center, University of Louisville, Louisville, KY;
| | | | - Karl Fagerström
- Smoker's Information Centre, Fagerström Consulting, Vaxholm, Sweden
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